More States Removing Barriers to Nurses’ Scope of Practice

Five years ago, the Institute of Medicine (IOM) released a groundbreaking report that called for the removal of barriers to advanced practice nursing—and state legislators are responding.

In March, Nebraska granted nurse practitioners (NPs) the ability to provide the full complement of services they are educated and trained to deliver. In May, Maryland enacted its own “full-practice authority” law. And similar legislation is pending in many other states.

“The successes have been fairly great,” Ken Miller, PhD, RN, FAANP, president of the American Association of Nurse Practitioners (AANP), said at a panel discussion in Washington, D.C., about the impact of the IOM report. “It was definitely a launching point,” adds Taynin Kopanos, DNP, NP, AANP’s vice president of state government affairs.

The report calls for a radical transformation of the nursing profession to improve health and health care. A key recommendation is to remove barriers that prevent nurses from practicing to the full extent of their education and training. Doing so, the report states, will improve patient access to high-quality care, especially in remote and underserved areas.

An Uptick in New Laws

In the last four years, seven states—including Maryland and Nebraska—have enacted laws granting NPs full practice authority, bringing the total number of states with such laws to 22 (including the District of Columbia). Other states have passed less sweeping laws lifting other restrictions on the practice of advanced practice registered nurses (APRNs).

The report seemed to light a fire under the slow-burning nurse licensure reform movement. Before 2010, progress was “very slow,” Kopanos said, noting that one or two states were enacting laws granting NPs full practice authority every three to five years. But the pace of change has accelerated since then. “We are seeing an uptick both in the number of states that are taking action and also in the number of states interested in taking action,” she said.

More signs of progress: Insurers are providing fuller coverage of NP-provided care, states are increasingly recognizing NPs as competent professionals, and the nurse licensure reform movement, once driven almost entirely by nurses and nursing organizations, is drawing support from a much broader range of groups and individuals, Miller said. Since 2010, the National Governors Association, the National Conference of State Legislatures, AARP, and other groups have endorsed efforts to remove practice restrictions on APRNs.

Still, legislators in many states have run into formidable opposition—particularly from organized medical groups at the state and national levels—in their efforts to remove practice restrictions on APRNs, Miller said.

“So where do we go from here?” Miller asked. “We have to continue to educate the legislators, we have to work with federal agencies to provide neutral language to their outdated rules and regulations, work with stakeholders to decrease costs and provide safe quality care in a timely fashion, and continue to provide care to the most needy in rural and underserved areas of the country.”

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